EDS continues to make progress in programming its system to process claims for the various types of medical and dental
services covered by HealthChoice. As of June 29, 2009, over 1.7 million claims have been processed totaling more
than $270 million in payments. As indicated in previous communications with you, catching up on the backlog
has been slow, but EDS is taking several steps to eliminate the backlog including adding a number of new positions,
leveraging resources from other EDS accounts, and hiring an external vendor to provide additional onsite resources.
For assistance with a claim issue you have been unable to get resolved,
please email EDSResolution@sib.ok.gov with the details of the claim.
For security reasons, please include the member ID number in your email instead of the member’s Social Security number.
We deeply regret the difficulties the backlog of claims has caused and will continue to provide you with regular updates. Thank you for your patience.
For additional information on claims processing, click here.
Members have recently reported to HealthChoice that they have received fraudulent calls
from someone inquiring about their prescription drug coverage and asking them to verify their date of birth.
Please note that neither HealthChoice, nor any of our partners such as EDS Administrative Services,
Medco Health, or GHS Property & Casualty, will ever contact you to request your personal information.
Never give your personal information to anyone who contacts you by telephone.
If you become suspicious of a caller, end the call immediately, and contact the business or organization the caller claims to represent.
Be smart and always protect your personal information!
You can now access ClaimLink to check the status of your medical and dental claims,
your deductible status, and your eligibility. You can also print a temporary health
and/or dental ID card. Click on ClaimLink in the menu to the left.
If you used ClaimLink prior to January 1, 2009, you must create
a new account and login to access the site now.
OSEEGIB hopes that this information will help those Section 125 Plan participants who may not have received their EOBs before their required filing deadlines.
The filing deadline for the previous Flex Year is different for some of the HealthChoice employer entities.
For example, State employees must file their Flexible Spending Account (FSA) Claim with EBC by March 31, but other entities
may require a different date because their Flex Year may end on another date. If you are an active state employee and
have a question or concern regarding your health reimbursement account, please call the Employees Benefits Council
at 1-405-232-1190 ext 301. All FSA participants should know that they must go ahead and file their final FSA
Reimbursement Claim with their usual Plan Administrator no later than their required filing deadline, even if they do
NOT have a HealthChoice EOB to attach. The timely filing of the FSA claim will trigger a protection allowed under the
U.S. Department of Labor Regulations. [29 C.F.R. Sec. 2560.503-1 (h)] Those FSA claims will be denied, but the member
will have 180 days to provide documentation (i.e.) the Explanation of Benefits, as an appeal of that denial.
Thank you for your patience and continued cooperation during this transition. Although initial progress was slow, we continue to work closely with
EDS staff to ensure claims processing and customer services call centers are running according to all contractual guidelines.
OSEEGIB also continues to work with multiple member associations to keep members informed of progress and trends during this time.
Our focus remains on processing all claims received according to state guidelines and procedures as accurately and expeditiously as possible. Since
the go-live date, EDS has processed 1.7 million claims, and more than $285 million in payments have been made through mid June. EDS is
now operating close to the same capacity as the previous claims processor.
While OSEEGIB and EDS continue to work together to resolve coding and benefit determination issues, EDS has taken the following steps to resolve the call center issues:
- EDS has increased its original 46 phone lines to 120.
- EDS has increased its original telephone call center staff of 18 to 30. Call center hours are 7:00 a.m. to 7:00 p.m. Central time, Monday through Friday.
We are monitoring the progress and will ensure that EDS takes the steps necessary to provide the highest quality customer service to callers.
Again, we apologize for the inconveniences this implementation has created.
Sincerely,
Bill W. Crain
Administrator
In partnership with the Oklahoma Tobacco Settlement Endowment Trust and the Oklahoma State Department of Health, HealthChoice continues to
receive recognition throughout the state for its expanded tobacco cessation program which was rolled out last year. Analysis of the first year’s success
reveals a six-to-one return on investment! The program supports Governor Brad Henry’s Strong and Healthy Oklahoma program which calls on
Oklahomans to “Eat Better, Move More, and Be Tobacco-Free.”
Participation in 2009 is also off to a good start with over 500 participants enrolled so far. In 2008, there were nearly 3,400 participants taking
advantage of the enhanced benefit which provides active and retired HealthChoice members as well as their enrolled dependents age 18 and up,
with two 90-day courses of treatment per year of any FDA-approved tobacco cessation product. Members need only pay their pharmacy copay if
they use the HealthChoice Pharmacy Network. The HealthChoice Plans pick up the rest of the cost.
Participants also have free access to Professional Quit Coaches® at 1-800-QUIT-NOW (1-800-784-8669), through the OKLAHOMA TOBACCO
HELPLINE. The same help is available in Spanish at 1-800-793-1552. Studies have concluded that a combination of FDA approved tobacco
cessation products and coaching is by far the most effective way to successfully quit tobacco.
For more information, call HealthChoice Member Services at 1-405-717-8780 or Toll Free 1-800-752-9475.
July is designated Eye Injury Prevention Awareness Month by the U.S. Department of Health and Human Services. The focus of this campaign is to make you aware of the importance of protecting your eyes.
Many eye injuries occur at the workplace. The most common type of injury happens when something irritates the outer surface of your eye which can be caused by falling or flying objects, or sparks striking the eye.
The Federal Occupational Health agency recommends protecting your eyes by following these guidelines:
- Always wear appropriate safety eyewear for the type of job you are doing.
- Make sure safety eyewear fits properly.
- Do not wear regular eyeglasses.
In addition to wearing proper safety eyewear at work, there are some preventive measures you should take to protect your eyes in all areas of your life such as:
- Outside: Always wear sunglasses to help protect your eyes against the UV rays of the sun. UV light contributes to the hardening of your eye lenses and the possible development of cataracts.
- During the 4th of July holiday, always wear protective eyewear whether you are setting off fireworks or watching from the sidelines. The eyes are one of the most common
injured parts of the body during this holiday.
- In the house: If you are cleaning with strong chemicals, make sure you are working in a well ventilated area and that the spray nozzle is turned away from
your eyes. Certain chemicals are extremely hazardous, and when they make contact with your eyes, they can cause permanent damage.
- In the garden:Always wear protective eyewear if you are mowing, raking, or edging. Rocks or debris could fly up and damage your eyes.
- In your workshop or garage: No matter what type of project you are working on, you should always wear safety eyeglasses. Whether it is sparks, fumes, unexpected
flying objects such as nails or wood debris, your eyes could be seriously injured without any type of protection.
- Around your car: Keep a pair of safety eyeglasses in your car at all times. If you have to jumpstart your car for instance, sparks from the battery, or battery acid could damage your eyes.
- In sports: You have to wear a helmet when playing many sports, so why not wear protective eyewear as well? Your eyes could easily be injured while playing
football, basketball, baseball, squash, or hockey. More than 31,000 eye injuries occur each year due to sports activities.
Accidents do happen, so you should always keep a pair of safety eyeglasses on hand. Look for a pair labeled ANSI Z87.1, which indicates they meet safety criteria from the National
Standards Institute and enjoy a life with healthy eyes!
Sources: The Federal Occupational Health Agency and the American Academy of Ophthalmology
When shopping for sunscreen products, you may have noticed that the sun protection factor (SPF) numbers have been getting higher. Some members
of the medical community have expressed concern about the higher SPF numbers. They believe the higher numbers will lead people to believe
that they are safe from the damage caused by ultraviolet (UV) radiation.
The following information offers a basic understanding of UV rays, how sunscreen products work, and protecting yourself from sunburn, premature aging of the skin, and skin cancers, including melanoma:
UV Rays
- There are several kinds of UV rays, but the two most dangerous are UVA and UVB rays. UVA rays penetrate deep into the skin while UVB rays damage the skin’s surface.
- UVA rays can pass through window glass, so you can damage your skin while riding in a car.
How Sunscreens Work
- Sunscreens absorb, reflect, or scatter UV light and provide either a physical or chemical barrier.
- Physical sunscreens reflect or scatter UV light by creating an opaque film. Look for zinc oxide and titanium dioxide on the label.
- Chemical sunscreens absorb UV light before they can cause damage. For broad spectrum coverage (protection from both UVA and UVB), look for
avobenzone (Parsol 1789), oxybenzone, sulisobenzone, ecamsule, titanium dioxide, or zinc oxide, PABA, and/or mexoryl (Anthelios SX) on the label.
- Make sure your sunscreen has not passed its expiration date. Sunscreen should be thrown out if it is older than two years. If your product does not have an
expiration date on the container, use a permanent marker to put your own expiration date on it.
Protecting Yourself from Sunburn
- Protecting Yourself from Sunburn
- Apply sunscreen at least 30 minutes before going out in the sun. Don’t forget to put sunscreen on your ears, back of the
neck, under bathing suit straps, and under the edges of clothing. Be aware that most all sunscreen products will stain clothing.
- To cover an average size adult, approximately one ounce of sunscreen should be used.
- Sunscreen should be reapplied every two hours or more often if perspiring or swimming, and also after toweling off.
- Sunscreens can no longer be labeled waterproof, sun block, or all-day since all sunscreens wash off to some extent.
- SPF numbers can be deceiving. For example, SPF numbers on sunscreens refer only to the product’s UVB protection factor.
- When properly applied, sunscreens provide a percentage of protection from UVB rays.
- SPF 30 screens 97 percent of UVB rays
- SPF 15 screens 93 percent of UVB rays
- SPF 2 screens 50 percent of UVB rays
- Skin reactions can occur when using sunscreen, and may be the result of added ingredients, such as fragrances, preservatives, or
the chemicals that provide sun protection.
- If you have a certain condition, such as lupus, or are taking medications, such as antibiotics or antihistamines, you may be more sensitive
to sun exposure. Take care to properly apply a sunscreen with an adequate SPF.
Alternatives to Sunscreens
- Avoid the sun between 10:00 a.m. and 4:00 p.m.
- Seek out shaded areas.
- Wear protective clothing.
While you’re not encouraged to shun the sun, you are encouraged to take precautions against sun damage.
Sources: American Academy of Dermatologists, Mayo Clinic, U.S. Environmental Protection Agency, National Cancer Institute
Summer is here and so are the bugs. As the weather gets warmer, the outdoors gets a little more inviting; unfortunately, humans are not the only ones that enjoy
warmer weather. Bugs – ticks, mosquitoes, flies, and bees – are also out and about.
While ticks are usually harmless, a bite can lead to Lyme disease or Rocky Mountain spotted fever. Mosquitoes can spread diseases like St. Louis
encephalitis and West Nile virus, and flies can inflict a painful bite that can last for several days causing swelling and sometimes
infection. When it comes to bees, most reactions to bees and other stinging insects are mild; however, severe allergic reactions can be
deadly. An allergic reaction can happen even if a person has been stung before and had no signs of an allergic reaction.
If this is something you want no part of, read on…
Things you can do to keep insects away.
- Use structural barriers such as window screens and netting.
- Avoid wooded, brushy and grassy areas when possible. Ticks particularly like these kind of areas.
- Don’t wear heavily scented soaps and perfumes.
- Use caution when eating and drinking outside; don’t leave drinks and garbage uncovered.
- Bright colors attract bees, so avoid wearing them while spending time outdoors.
- Wear long sleeves and long pants when possible.
- Tuck pant legs into socks or shoes.
- Wear a hat for extra protection.
- Get rid of containers with standing water; this will eliminate mosquito breeding areas.
- Use insect repellent if nonchemical methods are ineffective and you plan to spend time in tall grass or woody areas.
I found a tick! What should I do?
Ticks are easier to spot on light-colored clothing. Check for ticks after coming in from outdoor activities. If you find a tick, remove it
with tweezers by grasping the tick as close to the skin as possible and pulling it straight out. According to the Food and Drug
Administration, you should then drop it in a plastic bag, seal it up, and throw it away. It’s important to remove ticks as early
as possible, because generally, it takes about 36 hours for a tick to spread Lyme disease. After removing a tick, cleanse the
area of the bite with antiseptic, such as rubbing alcohol or soap and water.
How do I treat a bee sting?
It’s best to scrape a stinger away with a side-to-side motion using a straight-edged object like a credit card. Don’t use tweezers as this may cause more venom
to be pushed into the skin. After removing a stinger, wash the area with soap and water. To help reduce swelling, if present, apply ice or another cold compress.
Just about everyone experiences itching or pain after a bee sting. Oral over-the-counter (OTC) antihistamines can help relieve the itchiness. For the relief of pain
from bites and stings, you can use oral OTC drugs, such as ibuprofen and acetaminophen.
There are also many topical OTC drugs that can be applied to the skin to provide some itch and pain relief. Some of these topical OTC drugs are labeled
as “external analgesics” or “topical analgesics.” They contain ingredients such as hydrocortisone, pramoxine, and lidocaine.
For those who have a history of severe reactions to bee stings, check to see if the victim is carrying an epinephrine auto-injector (EpiPen®). If so, help the
victim use the device as directed. If the victim is supposed to carry one of these devices and does not have it, call 911 immediately! Don’t wait for symptoms to appear.
Can I use insect repellent and sunscreen at the same time?
According to the FDA, it’s okay to use insect repellent and sunscreen at the same time. The general recommendation is to apply sunscreen first then
apply the repellent. There are also some combination products that contain both insect repellent and sunscreen. Sunscreens are regulated
by the FDA as an OTC drug. The Environmental Protection Agency (EPA) regulates insect repellent products.
What is the proper way to use insect repellent?
You can use insect repellent on clothes or skin, but never on the face. Be aware that insect repellent can be harmful to babies. If you use insect
repellent on older children, it should contain no more than 10% DEET. Try to avoid applying repellent to children’s hands, around the eyes, or areas
where there are cuts, scraps or irritated skin.
Once you’re finished with outdoor activities, wash the skin with soap and water to remove repellent. If by chance you experience a reaction to an
insect repellent, wash the repellent off with soap and water and contact a Poison Control Center (1-800-222-1222).
Mosquitoes, biting flies, and ticks can be very annoying and they do sometimes pose a serious health risk. Don’t let bugs ruin the season for you. Remember
to protect yourself and your children, and then know what to do when an insect bite occurs.
Source: Food and Drug Administration
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